Avoid Insulin-Related Adverse Events When Treating Hyperkalemia: Could Impaired Awareness of Hypoglycemia Play a Role?
Abstract
Based on our clinical experience, we speculate that type 1 diabetes mellitus could contribute to a higher level of the aforementioned risk. One of the reasons for this could be impaired awareness of hypoglycemia, which might be present in 30% or an even higher portion of patients.
Therefore, we would also recommend that providers consider asking the patient about his/her ability to recognize hypoglycemia or perform a simple Gold method. The Gold method poses the question to patients, "Do you know when your hypoglycemic episodes are beginning?" The respondent then completes a 7-point Likert scale, with 1 representing "always aware" and 7 representing "never aware." A score of GREATER-THAN OR EQUAL TO4 implies a level of impaired awareness of hypoglycemia, and these patients should be monitored for possible hypoglycemia with greater attention.
Impaired awareness of hypoglycemia may also be present in persons with type 2 diabetes7 (especially those treated with insulin or sulfonylurea derivatives), who could benefit from the procedure as well. We believe that such a simple step could further decrease the risk of hypoglycemia after the insulin treatment of hyperkalemia in patients with diabetes mellitus.